Improving Neuropathy with Functional Medicine and Genetics

DNA blackboard drawing
Is Genetics The Piece We Have Been Missing?

 

Improving Neuropathy With Functional Medicine and Genetics

The current approach for the treatment of neuropathy has not been very successful. There are millions of people that suffer with this condition all across this country. There are several reasons for this failure in part because there are so many causes of neuropathy and in part because the treatment is not directed towards the whole body. The field of medicine addresses symptoms, diagnosing the problem and then prescribing a medication that hopefully will suppress the symptoms.

The cause is rarely found or for that matter rarely searched for. Sure the diabetic or chemo induced neuropathy are relatively easy to diagnose. What is required is a whole body approach. A cure for neuropathy will never be found if we continue with our current approach.

A whole body approach for example for the diabetic neuropathy would be to prescribe dietary guidelines to normalize the HbA1c or the blood sugar levels.   Exercise would be prescribed to improve the insulin sensitivity. Supplementation would be recommended to assist in the reduction of inflammation, repairing of the cell and nerves, improve digestion and assimilation, detoxification and elimination.

This approach would be slightly different and personalized for that individual dependent upon their causes, lab markers and of course their genetics.

Genetics is proving to be a game changer when working with chronic patients.   It allows us to interpret potential vulnerabilities in methylation, (the utilization of B vitamins and Folate), detoxification, ability to handle chemical toxicity or pesticides, production of choline a necessary component in the myelin, and the body’s ability to produce glutathione the major antioxidant.

When I evaluate the root causes of all chronic issues including neuropathy I always look at these 6 factors: Inflammation, Methylation, Mitochondrial Health, Detoxification, Genetics and Autophagy.

  1. Inflammation: When our immune system is more over active producing more cytokines and inflammatory markers. There are a lot of reasons for this including the toxic environment we live in and the exposure of an enormous amount of chemicals, molds, and heavy metals. The processed foods we eat are loaded with preservatives, chemicals creating a very unhealthy environment in our gut and adversely affecting our ability to digest, absorb and assimilate our food.
  2. Methylation: This is our ability to convert green leafy vegetables into a useable form of folate and combine and manufacture enough B12 to allow us to detoxify, make neurotransmitters and produce anti-oxidants. Genetic markers for this are the MTHR, MTRR, MTHFD, MTR, COMT, NDUF as well as several others.
  3. Mitochondrial Health: The mitochondria are the battery of the cell. It provides energy in the form of ATP. If there is not enough energy production the body will have difficulty performing its necessary functions and fatigue or lack of endurance will set in.   This creates another set of problems within the cell with regards to the sodium and potassium pump and the exchange of key minerals. Ultimately, this affects the frequency of firing of the nerve and the slightest impulse can cause this nerve to be activated.
  4. Detoxification: It is important to address the ability to detoxify properly in the liver and its ability to convert these toxins to a water-soluble form. The interaction with digestive enzymes and bile is also important when looking at detoxification. Glutathione is our body’s major antioxidant and if we can see vulnerabilities in our ability to produce glutathione and help with the removal of chemicals and heavy metals. The PON1 gene is extremely common snp that I clinically see in practice. The function is the removal of pesticides in the body.   Also, the CYP1 and CYP2 genes need to be closely looked at. This is our cytochrome P450 system, which helps with the conjugation of the toxins and the conversion to the water-soluble form.
  5. Genetics: The role of genetics has to be taken into consideration. The specific vulnerabilities each of us has and the expression of these genes. There are several important genes to consider. MTHFR C677t and A1298c and its effects on methylation and the ability to produce neurotransmitter. The CYP1 and CYP2 genes and detoxification.   We want to take a close look at the NDUF genes and its impact on the mitochondria. NOS, SOD and GSTM1 for oxidative stress and glutathione production. The goal is to assess the individual for potential vulnerabilities and support the body to minimize of eliminate the expression of those genes.
  6. Autophagy: This is the ability of cell to clean itself from the debris. In other words if the trash keeps building up how can the cell or for that matter the mitochondria function properly.   The discovery of this process was recent and was so significant that it won the medical Nobel Prize. It has been linked to several of the chronic degenerative diseases such as Alzheimer’s, Parkinson’s, and Lou Gehrig’s disease.

With all chronic disease including Peripheral Neuropathy these six areas must be addressed along with diet and lifestyle changes.

Sleep

Exercise

Anti-inflammatory or Nutrient Dense Food Program

Mediation

Eliminate or Reduce Exposure to Toxins

Treatments and therapies are much more effective when they are personalized to that individuals particular problem. Is it methylation, mitochondrial dysfunction? I will say methylation will directly affect the mitochondria as well as detoxification.

When the mitochondria are affected, remember this is the battery; the energy of the cell, the first place it will affect is the brain and nervous system. It is our most energy dependent system in the body. The second place it will affect is the immune system and then finally the muscular system.

Dependent on what genetic snps we have there are certain supplements that help to restore mitochondrial health. It could be NADH, D-ribose, COQ10, Ubiquinol, Magnesium, Carnitine or Alpha Lipoic Acid.

The solution is slightly different for everyone and there is no one size fits all. We have to determine which of these or a combination of these 6 factors are affected and provide support nutritionally along with the lifestyle factors mentioned above. I strongly believe that with the right approach a cure could be found for those that suffer with Peripheral Neuropathy.

I am taking the proceeds from my book “Understanding, Managing and Improving Your Peripheral Neuropathy,” which can be purchased on Amazon, and have begun to do research on genetics and neuropathy.

The Functional Medicine Doctor is the best qualified to assist with the needs of the chronic patient.

Dr. Veselak is a graduate of the Functional Medicine University and has extensively studied in post -graduate courses Genetics and Functional Neurology.

In our clinic we specialize in Chronic Degenerative Conditions including Peripheral Neuropathy.

We consult with individuals from all over the world. If you have interest in this please email Dr. Veselak at dr.veselak@gmail.com  or

Call our office for an appointment. 805 482-0723

 

 

 

 

 

 

DID YOUR ANTIBIOTICS CAUSE YOUR CHRONIC HEALTH ISSUES?

Antibiotics such as Cipro, Levaquin, Avelox are a group of antibiotics called Floroquinolones. They are among the most commonly prescribed antibiotics in the United States.

With this class of antibiotics there are great risks that can come from taking these so make sure that when prescribed these that your condition is a serious one and not a minor problem like a UTI or sinus problem.

When I consult with people all over this country, several of the chronically ill have been “floxed” as has been termed, damaged by the Floroquinolones.   These individuals have had a neurotoxic reaction due to the ability of fluoride to penetrate the blood brain barrier and attack the brain.

I initially learned about this toxicity while researching for my book on Peripheral Neuropathy, “ Feet Don’t Fail Me Now.” Peripheral Neuropathy is just one of many problems that can occur due to this toxicity. More common symptoms are tingling, numbness, vertigo, loss of balance, memory issues, tendon ruptures, joint pain, ringing in the ears, rapid heart beat, intolerance to heat or cold, rashes.

So individuals that have been compromised by genetic susceptibilities, MTHFR, methylation, detoxification and the ability to handle chemicals and or toxins properly get a dose of these fluoride quinolones and this creates an inflammatory state in the body affecting the nervous system, musculoskeletal, gastrointestinal, and autonomic and cardiovascular system.

As we have learned with Genetics they can be turned on and off by diet and lifestyle changes. With floroquinones there can be an immediate reaction and or a cumulative effect where it actually will build up in the system and can affect you years down the road.

Is it possible that taking Cipro created the Peripheral Neuropathy or Tinnitus years down the road? Is this what idiopathic neuropathy is? Where there is no known identifiable cause but it is a chemical toxicity caused by an insult to our peripheral nervous system.

It has also been reported that this can than cause an increase in oxidative stress and consequential mitochondrial damage. This creates an incredible amount of fatigue, as the mitochondria function is to produce ATP, the energy of the cell. In my research with treating thousands of patients I have come to learn how important the mitochondria is for restoring a person back to health. In the past I would focus on adrenals and thyroid, which still play an important role, however if the mitochondria are not healthy than the body cannot protect itself from the continual onslaught of oxidative stress and the ability to produce energy, there will be no recovery.

Genetics does play a part. Besides the MTHFR gene, the CYP, NDUF, G6PD, NOS, CAT and SOD are important snps for methylation, detoxification and mitochondrial health.

There is no known cure for Floroquinolone toxicity however supporting the mitochondria, reducing oxidative stress, reducing brain inflammation, glutathione support and improve the detoxification pathways is a great place to start.

Functional Medicine focuses on finding the root cause of the problem. When discovered solutions become much clearer.

 

VITAMIN B12: 4 CHOICES WHICH ONE IS BEST FOR YOU?

The more we learn about methylation and MTHFR we realize how important B12 is. I am going to discuss the different types of B12 as it relates to methylation, absorption and genetics and which type might benefit you.

There are four types of Vitamin B12, Cyanocobalamin, Methylcobalamin, Adenosylcobalamin and Hydroxocobalamin

The first, Cyanocobalamin is not very good and we recommend never using it. It is synthetic or a man made form of B12. It takes the body more steps to convert it to a useable form of Hydroxyl B12.  Cyanocobalamin is commonly found in energy drinks.

Methylcobalamin is an active form of B12, which helps with the metabolism. It is basically cobalt attached to a methyl group. It is beneficial in methylation because it activates an enzyme called methionine synthase. This helps the myelin sheath of nerves as well as it helps to make red blood cells. Methionine synthase also plays a very important role in converting Homocysteine into methionine. This helps reduce the amount of Homocysteine in the body, which can at high levels cause cardiovascular as well and neurological damage.

Methionine is also utilized through the MAT enzyme to convert it to SAMe. It is the body’s major methyl donor, which is very significant for the breakdown of neurotransmitters (COMT) and breaking down histamines (HNMT).

The best dietary sources of B12 are animal products such as Meat, Poultry, Fish and Eggs. It is very common for people to be deficient in B12. Primarily because of the complex process that is required to absorb it, methylate it and assimilate it. For B12 to work properly it much combine with methylfolate as part of the methylation process to make methionine synthase.   Individuals with the MTHFR gene are already functioning at a 20-50% reduction in converting folate to methyl folate.

Foods Highest in Vitamin B12 (Cobalamin).

Some other causes of B12 deficiency are: Vegan Diets, Antacids, Bariatric surgeries, Alcohol and Pernicious Anemia.

The lab tests MCV and MCH if elevated suggest a B12 or Folate deficiency.

Too much of methyl B12 can cause megaloblastic anemia. A condition where you have high amount of red blood cells, hemoglobin and hematocrit in your CBC blood lab tests.

Adensosylcobalamin is the mitochondrial form of B12. It is great for energy and can be utilized for a person that is experiencing fatigue throughout the day. It can also be successful for the individual that exercises and experiences more muscle aches and fatigue following exercise.

Methylmalonic Acid is the gold standard test, to see if the patient is deficient in Adensosylcobalamin.   A high methylmalonic acid suggests B12 adenosyl deficiency.

Hydroxocobalamin is most beneficial to lower Nitric Oxide levels. If there is an abundant amount of nitric oxide in the body this creates too much ROS, reactive oxygen species. It is not uncommon to see elevated nitric oxide levels with chronic fatigue and autoimmune issues. To complicate matters are the eNOS and SOD snps. Generally, supplementing with SOD and Hydroxycobalamin are beneficial to lower the ROS and the nitric oxide levels.

Dependent on various SNP’s (single nuclear polymorphisms) at the COMT and VDR certain combinations can prove effective as outlined by Dr. Amy Yasko. I have followed her formula with success in my Functional Medicine/Genetic Coaching.

COMT V158                          VDR Taq                   B12 Types well tolerated

—                                           ++ (TT)                   All three types of B12

—                                           +- (Tt)                      All 3 with less methyl B12

—                                           — (tt)                       Hydroxyl and Adenosyl B12

+-                                          ++                             All 3 types with less methyl B12

+-                                          +-                              Hydroxy and Adenosyl B12

+-                                          —                               Hydroxy and Adenosyl B12

++                                         ++                             Hydroxy and Adenosyl B12

++                                         +-                              Hydroxy and Adenosyl B12

++                                         —                               Hydroxy B12

 

I recommend Pure Encapsulations Adenosyl/Hydroxy B12 liquid

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It can be found on my website store in liquid or capsule form. https://www.purecapspro.com/drmichaelveselak/pe/products/product_details.asp?ProductsID=2312

MTHFR AND ANXIETY

 

ANXIETY AND MTHFR

Anxiety is quickly becoming the most common complaint in my clinical practice as well as my online consultations.

The MTHFR gene plays a critical role in anxiety as well as depression.  When this gene expresses is creates an inability for our body to utilize folate in our body which is critical to many pathways in our body.

The two most researched genes with regards to anxiety and MTHFR are the A1298C and the C677T.

If you have the A1298C variant this can affect the biopterin pathway which can lead to problems such as:

  • Neurotransmitter disturbances (Which can lead to mood and behavior disorders such as depression, anxiety, ADD, ADHD and learning difficulties.)
  • Nutritional imbalances (Amino acid difficulties leading to neurotransmitter problems).

How much will you be affected if you have the A1298C gene mutation?

There are two different types of the A1298C gene mutations, these are referred to as heterozygous and homozygous.

  • Heterozygous = 1 copy of the gene from your father or mother
  • MTHFR A1298C heterozygous = 20-30% loss of function.
  • Homozygous = 2 copies of the gene, one each from your father or mother
  • MTHFR A1298C homozygous = 40% loss of function

Common Difficulties with the A1298C mutation

The majority of problems experienced with the A1298C gene mutation are associated with neurotransmitters.  Neurotransmitters such as dopamine, serotonin, norepinephrine and epinephrine.  These are chemicals that affect are mood, how we react to stress, our ability to focus and concentrate and our ability to relax.

For example, if you have the A1298C gene mutation you will have more of a propensity to have neurotransmitter issues.  This can lead to mood and behavior issues that can impact significantly ones health.

There are a few other genes that are important to look at when dealing with anxiety and depression. These genes are COMT, MAOa, MAOb, and GAD.  We must always look at the entire picture and not just focus on one gene.

The MTHFR gene is critical in the biopterin pathway and neurotransmitter production.  It is also critical in the Folate and Methionine Pathway and ultimately how it influences homocysteine, the production of glutathione and detoxification.

For those of you that have the MTHFR C677T gene mutation you will have symptoms associated with:

  • Folate metabolism
  • Homocysteine
  • Methylation issues
  • Nutritional imbalances Detoxification (reduced ability to detoxify properly leading to toxicity problems)

Similar to the A1298C mutation you can be heterozygous or homozygous, 1 or 2 copies of the gene from mom and or dad respectively.

  • MTHFR C677T heterozygous = 30-40% loss of MTHFR function
  • MTHFR C677T homozygous = 60-70% loss of MTHFR function

Generally the problems we see with the C677T mutation are elevated homocysteine, cardiovascular disease, stroke, heart attack or deep vein thrombosis.

The problems experienced by the C677T gene mutation include elevated homocysteine which can lead to cardiovascular disease, stroke, heart attack, deep vein thrombosis.  Family history of associated diseases is also common.

As you can see the MTHFR gene mutation can lead to some serious health issues.  I can’t stress enough the importance of consulting with a practitioner that understands the complexity of this issue as well as how epigenetics can affect you and nutrigenomics can reduce the risks associated with the mutation.

Can I have a combination of C677T and A1298C at the same time?

There are some people that have both the C677T and the A1298C gene mutation.  In these situations there can be a combination of symptoms including neurotransmitters, homocysteine elevation and folate metabolism.  Often times these situations become more complicated in trying to navigate the solution by yourself.  I highly recommend that you have the genetic profile be evaluated by a practitioner trained in this.  This will greatly improve the outcomes.

Please call us at 
(805) 482-0723 to schedule your consultation

INTERPRETING YOUR 23ANDME GENETIC DATA

 

INTERPRETING YOUR GENETIC VARIANT REPORT

On a weekly basis we consult with and receive numerous emails and phone calls from individuals with chronic health problems.  Recently, more of these people have already done their genetic testing through 23andme and have received their genetic variant report from companies like Livewello.   The difficulty however is how to navigate this complex roadmap of information.  Often times as we have all discovered it is not as easy as supporting just the MTHFR gene.

TREAT THE PATIENT NOT THE GENE VARIANT

It is very important to remember it is not about supporting all the genetic variants that the reports suggest.  The key is to treat the patient, the actual symptoms not the genetic snps.   In our opinion to provide supplement advice as some of the genetic variant reports do is irresponsible and more often than not will not provide improvement of the symptoms.

IT IS IMPORTANT TO HAVE AN EXPERT INTERPRET YOUR GENETIC VARIANT REPORTS

As I have stated it is important to understand that every person is different in their symptoms and their genetics.  A cookbook approach of one size fits all for the most part just does not work effectively.  The benefits of  the genetic variant report is too correlate it with the patient symptoms as well as other labs to determine if the genes have actually expressed themselves.  The information than allows us to personalize treatment programs to each individual.

MTHFR AND MORE

The MTHFR is the gene that there has been the most amount of research.  However, there is much more than supporting just the MTHFR gene. For instance there are some other genes that must be addressed when dealing with patients symptoms, such as COMT, CBS, CYP genes.  The entire picture must be analyzed and correlated with the individuals symptoms for optimum results.

WHY CHOOSE US

We provide a personalized support program that considers your genetic raw data along with your symptoms to assist you in understanding your chronic health problems.   Dr. Veselak is Board Certified in Integrative Medicine and a Functional Medicine Practitioner.  This expertise provides him insight into providing you with the necessary tools to help you support and improve your current health symptoms.  He understands how the genetic variants can affect your symptoms and if the genes have actually expressed creating or enhancing the current health problems.

 

WHAT YOU WILL LEARN FROM THE PERSONALIZED REPORTS

  • Discover the genes that are affecting your current health status
  • Provide you the tools to improve your health
  • Dietary and lifestyle changes to minimize or eliminate gene expression
  • Correlation of current symptoms with genetic variant report
  • Analysis of previous labs with genetic variant report
  • Recommendations of further testing if necessary
  • Access to a knowledgeable practitioner via phone, Skype or email for questions you have

 

WE OFFER SEVERAL DIFFERENT CONSULTAION OPTIONS DEPENDING ON YOUR NEEDS

  • You have your genetic variant report and want information as to what genes might be causing your symptoms and interfering with your ability to heal
  • Would like personalized care and follow up care
  • We offer 3, 6 and 12 month care programs
  • Our comprehensive programs provide recommendations for nutrition, lifestyle, dietary guidelines, review of labs, further testing
  • Email, phone or Skype consults available

Our office is accustomed to providing online distance consults.  So if you are having questions regarding your genetic variant reports please contact us here.

Dr. Michael Veselak, D.C. BCIM, CFMP

(805) 482-0723

Dr.veselak@gmail.com

 

MTHFR and Folic Acid

Why Folic Acid Is Bad For MTHFR

Diet and Lifestyle factors are very important for genetic expression.  Folic Acid if you have a MTHFR genetic variant is not good for you.  Folic Acid is not the same as Folate.  Folic Acid is actually the synthetic form of Folate; these are manmade substitutes for real Folate. Our bodies can’t process is and in many cases we lack the enzymes to convert it to a useable for. It takes our body 4 more steps to convert folic acid to L-methylfolate.  It requires the MTHFR gene.

 

The excess folic acid will be stored in the body as toxins in our tissues and organs.

Unfortunately, many foods these days are enriched with folic acid.  It has been added to foods such as bread and cereals because there was research that showed that it lowered the incidence of neural tube defects in newborn babies.

There is also research suggesting that with the supplementation of folic acid it can also increase the incidence of miscarriages due to the increased level of toxicity in the body.

Even in a lot of prenatal vitamins the folic acid, the synthetic form is found.  I have had patients that were having difficulty conceiving or had frequent miscarriages and once I ran the genetic test showing a MTHFR defect our treatment plan became more personalized.  In these cases we instructed the patient to avoid all supplements with folic acid and all fortified foods with folic acid.  It is important to read the labels on your food to avoid this common mistake.

There are other health problems associated with unmetabolized folic acid such as cognitive impairment, anemia and cytotoxicity.  The risk of supplementing with folic acid is too great.

RECOMMENDATIONS TO AVOID COMPLICATIONS FROM FOLIC ACID

  • Have genetic test to evaluate MTHFR gene
  • Read Food Labels
  • Avoid Folic Acid Supplementation

RECOMMEDATIONS IF HAVE MTHFR MUTATION

  • Eat green leafy vegetables
  • Supplement with Folinic Acid or Methyl Folate

 

MTHFR and MORE

You have just discovered through testing that you have the MTHFR gene variant.  Now what?  These days there is so much information online regarding MTHFR that you initiate a self treatment protocol.    I understand this method as the internet recommendations seem so appropriate and clear.  Occasionally the answer might be this simple.  However, more often than not there are deeper issues or other genetic variants that need to be addressed.  Is your body absorbing the B12?   Did the supplementation with methyl folate and methyl cobalamin  exhibit adverse symptoms?

On a weekly basis we consult with numerous patients that have “MTHFR” variant and have tried the self treatment approach without benefit.  They are extremely frustrated at the lack of improvement or by the lack of knowledge by their primary care physician.

MTHFR AND MORE

I will tell you it is much more complicated than prescribing methyl folate for the MTHFR gene variant.  I have had patients that are sensitive to increasing methylation such as methyl folate or methyl cobalamin.  The whole picture including other genetic snps (single nuclear polymorphisms) must be addressed along with the symptoms of the patient.  The MTHFR gene is an extremely important gene, and the most researched, but in of and by itself in only assists with a part of the clinical picture.  I adhere to the more comprehensive and personalized approach rather than taking a dart and hoping I hit a bullseye.

LOW AND SLOW

I have discovered it is much more beneficial to begin my protocols very slowly in low dosages to avoid any adverse reactions.  There are certain genes that need to be addressed before or after the MTHFR to successfully support the patient’s path to good health.  We must emphasize we do not treat the genes but rather the patient and their symptoms.

EVERY PATIENT IS UNIQUE

We are all provided with our unique set of genes and mutations.  As well we are all exposed to various environmental toxins, stress, bacteria and or viruses.  These epigenetic factors can lead to gene expression.  Just because we have a mutation does not necessarily mean we have expression.  The mutations lead us to susceptibility which can be supported through proper nutrition to minimize chances of expression.  When we analyze a genetic variant report we focus on all the genes as well as the patients symptoms and other lab results they might have.

WHAT IS THE OPTIMUM PROTOCOL FOR MTHFR

  • Understand the big picture, analyze all the genes not just MTHFR
  • Epigenetics plays an important role
  • The Doctor you choose must understand Nutrigenomics
  • Your genes and your treatment are unique to you, there is no cookbook approach
  • Treatment is personalized
  • Seek a health professional that is familiar with MTHFR, Epigenetics, Nutrigenomics and COMPLETE Genetic Variant Report
  • Do not begin with methyl folates
  • Correlate Symptoms to Genetic Variants
  • Proper order of Supplementation for optimum results
  • Continued support to navigate the genetic roadmap

If you have any questions about our MTHFR protocols please contact us here.

Dr. Michael Veselak, D.C. BCIM CFMP

(805) 482-0723